Exploring the Social Norms, Their Development, and Influence on Complementary Feeding in High- and Upper-Middle-Income Countries: A Systematic Review

Context: Complementary feeding is a window of opportunity for optimal growth and development of eating behaviors and preferences. Social norms influence parents’ complementary feeding decisions; however, we lack an understanding of what these norms are.

Objective: This mixed-methods systematic review aimed to determine the social norms surrounding complementary feeding and their development and influences in high and upper-middle income countries.

Data Sources: Systematic searches were performed using 5 databases: Medline, CINAHL, PsychInfo, Scopus, and EmCare. Studies were eligible if they included caregivers of children aged 0–5 years and focused on social norms relating to complementary feeding. Records were screened in duplicate.

Data Extraction: Findings were synthesized using Bayesian methods and categorized by objective.

Data Analysis: The search identified 8419 articles, of which 34 articles reporting on 33 studies were included. This review found social and cultural norms around the timing of introducing complementary foods, first foods to introduce, types of foods to provide, feeding method, food preparation, family meals, infant weight, and social contexts. Social norms influenced intentions and behaviors around introducing complementary foods and were created and reinforced by various socioecological influences, including family, peers, health professionals, community, broader society, culture, religion, and education.

Conclusion: Social norms should be considered by health professionals and in public health initiatives to support families to meet nutritional recommendations, especially among migrant populations and/or those with strong family influences who might be exposed to norms that do not align with infant feeding recommendations. Longitudinal research is recommended to better understand the roles and influence of social norms throughout complementary feeding.

Systematic Review Registration: PROSPERO no. CRD42023424666